Project Summary/Abstract: Ventral and incisional hernia repair (VIHR) is one of the most common operations performed in the United States annually. A successful VIHR improves symptoms and removes the risk of life-threatening bowel emergencies, ideally without complications or recurrence. Currently, patient selection and decision-making in VIHR is guided by clinical outcomes and anecdotal data. Little is known, however, about patient-reported outcomes (PROs) after VIHR, such as postoperative function or quality of life, or how these outcomes interact with patient comorbidities or postoperative complications, especially in high-risk patients. Using patient- reported outcomes (PROs) to assess clinical performance from a patient perspective can help guide surgical decision making, aid in appropriate patient selection, and improve quality of VIHR. This research proposal focuses on gathering PROs after VIHR and examining the relationship between PROs, preoperative risk factors, hernia severity, and clinical outcomes. Clinical and patient-reported data will be drawn from the Michigan Surgical Quality Collaborative, a quality improvement program led by the University of Michigan that gathers data from patients undergoing operations across the state. The MSQC represents a unique clinical laboratory to study PROs across hospitals and surgeons on a population-based level. The research aims include using hierarchical linear models to examine (1) the variation in PROs as influenced by patient comorbidities, (2) the correlation between hernia severity and PROs, and (3) the association between postoperative complications and PROs. As recent national healthcare reforms have placed increased focus on patient-centered care as a determining point for reimbursement, this research attempts to shed light on the utility of PROs in defining surgical quality.